Wiki Concurrent vs. Sequential IV Infusion

crhunt78

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I am "stuck" on a chemotherapy infusion encounter and wondered if anyone else has come across something like this:

Mannitol - IV Infusion from 10:00 - 15:30
Decadron - IV Push at 11:00
Kytril - IV Push at 11:02
Pepcid - IV Push at 10:25

Cisplatin - chemo iv infusion from 11:40 - 13:10
Etoposide - chemo infusion from 13:10 - 15:10

Would the Mannitol infusion be coded as concurrent to the chemo infusions or, would it be coded as a sequential IV infusion with 1 additional hour? I am thinking that the hours it runs with the chemo are bundled because we are billing for the hours of the chemo infusion.

Any suggestions would be appreciated! Thanks! :D
 
This is based on personal experience only. Our clinic has decided to code this scenario as the 96367, 96366 x 4 for the Mannitol, based on some interesting information from 3 different external auditors that were performed on our clinic. We literally had three different views and none of them had supporting documentation. I tried to get a solid answer at last years AAPC National Conference and was unsuccessful.

The 96368 is not a time based code. The 96366 additional hours do not apply so you would be losing revenue. It is simply for a concurrent drug no matter how long it ran. We also heard from one auditor that the concurrent drug "has" to start at the same exact minute as the primary (chemo) drug infusion. This was never supported with any documentation.

This probably is a "facility" coding decision. Not necessarily anything that could be backed up with supporting documentation. But I am very open to see it if someone has something that would solidify this grey coding conflict.
 
Thanks for your reply, I keep coming across this same scenario with an infusion of magnesium. It is reported completely separate from the saline infusion so it's not hydration and the magnesium runs for about an hour prior to and then the entire time the chemotherapy runs. I can't find any documentation out there to clarify whether or not to code just 1 sequential therapeutic infusion for that 1 hour the magnesium ran or if I should code 1 sequential with 3 addt'l hours (96366 x 3) and the hours of chemotherapy. To me, it seems like that is double billing for drugs that are running at the same time through the same IV line. However, they aren't technically running concurrent because the magnesium has a different start time than the chemotherapy infusion.

I've posted this question in a different thread in this forum and have had no replies so it seems as if no one really knows the correct way to code this scenario. I appreciate any thoughts you might have or suggestions on what you think is the correct way to code these encounters.

Thanks!
 
The Mannitol runs independently from 1000-1140 (96367, 96366) then concurrently from 1140-1510 (96368) then independently again from 1510-1530 (no code). See below for breakdown

Mannitol - IV Infusion from 10:00 - 15:30 96368, 96367, 96366
Decadron - IV Push at 11:00 96375
Kytril - IV Push at 11:02 96375
Pepcid - IV Push at 10:25 96375

Cisplatin - chemo iv infusion from 11:40 - 13:10 96413
Etoposide - chemo infusion from 13:10 - 15:10 96417, 96415

When Mag/K= runs twice in one session - if the drug runs independently for an hour before chemo = 96367 then during chemo 96368 then a second bag is hung after chemo finishes for two hours 96366 x2 (you don't code a second first hour sequential if the drug runs twice at one encounter)

Hope this helps - I don't usually browse the threads but code chemotherapy for multiple facility-based infusion centers - I hope this helps.
 
Jbrown, would you kindly share your resources where the magnesium infusion run can be split into several different IV infusion codes.

A time based code is typically not split up and billed with separate different codes. The total time is used to bill the appropriate single infusion code based on CPT guidelines.

Just curious to new information that may be out there we are unaware of.
 
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